Reader feedback: Is limiting industry gifts a smart policy?

Arguments in favor of Stanford’s policy Gifts are a way of gaining preferred access and gifts are given to receptionists and nurses and others medical staff for the same reason--essentially bribing a company to get to see the doctor. With no gifts to influence access to doctors, doctors themselves can select the products, devices and techniques as well as the detail personnel who they wish to invite in to advise them of new developments. Why should access be gained by the highest bidder? – Anonymous I strongly endorse the move to limit gifts to physicians. In the short term it will limit marketing costs for the companies and eliminate the biasing of physician opinion by flashy marketing campaigns. In the long run it will drive the expansion of CME type programs, sponsored by state health authorities/insurance companies that will provide balanced education on new therapies. It will also eliminate the incentive for companies to invest precious R&D dollars on marginally incremental innovations that cannot be supported on the basis of scientific evidence. It is a shame that this move has not been adopted sooner by a larger number of institutions. - Swami Subramaniam, M.D., Ph.D Dr. Wei needs to take a look at his confusion concerning personal entertainment and his professional development…As with a lot of physicians, he is expecting freebies for his personal life. Dinner meetings with non-industry guests are social events, not professional development. Part of the due diligence a doctor owes himself (and the profession) includes making sure he stays on top of developments in his field. If he can only make meetings during family time and must bring his wife, it is a very simple matter to pay for her dinner on his own. - Anonymous Arguments against Stanford’s policy I think the whole attitude is a bit "Ivory Tower.” I feel fortunate to have open discussions with most of the drug reps I see. They will get information for me whenever I ask and having starter samples for paying patients and lots of samples for pro bono patients is a rational tradeoff. Some of the marketing money is not well spent, I agree. Pharma sponsored dinners are one way of seeing my colleagues and hearing the opinions of very competent doctors. - J. Reed, D.O. I agree with Dr. Wei completely. The interaction between Pharma and MD’s is already limited by the AMA guidelines which are much too stringent as it is. These industries should be able to interact and exchange information freely at least according what the AMA has already implemented. Anything more restrictive is simply intellectual fascism. - Douglas J. Krell, M.D. If the pharmaceutical industry wants to announce a new drug or product, what is wrong with it? In this process, if a doctor has to stand by and listen to five to twenty minutes of infomercial, why not reimburse that doctor in some way? Doctors are humans and potentially corruptible. Fortunately, most of us do not see a link between a trinket (including pens, paperweights, “take out Chinese food for office staff,’ a flashlight or measuring tape) that is left in our office as an inducement to prescribe a drug! The pharma sales people would have to come up with some method of reminding the doctor of their product. Between a highly decorated university professor talking about a drug over a dinner meeting and the pharma reps seeing me for a few minutes, dropping off what they think is relevant literature and a PDR insert with a few baubles, I would have more trust in the latter. Most sensible doctors can look through the haze of advertising and would look at the Medline, journals or Google to get more info in any case. This is more than just an ethical issue. For doctors practicing in the trenches, generous medication samples mailed in by drug companies or left behind by reps helps a lot of poor patients. Many times I have sent home a patient with a low paying job (not eligible for Medicaid or drug company indigent program) with samples of expensive drugs when it meant life or death or even worse choosing between a meal for family or the medications. Drug reps are pushy, flamboyant and try to sell their drug. Like actors, they get paid for their performance. They are just doing their jobs. Where we really need regulation is in pricing of drugs, and the scams like Part B, which effectively removes any incentive for meaningful indigent care programs. There should be strict regulation of doctors who are paid to speak on behalf of pharmaceutical products (a.k.a. “Thought leaders”), as they don’t look too bright in this role and it makes them less respectable. They have the sinister power to influence costly prescribing habits. In this case, simple disclaimers before drug-dinner talks is not OK! - Narayanachar S. .Murali, MD, FACP. FACG I feel that limiting industry gifts is a misguided, though well-intended, notion. I agree that pharmaceutical reps have significant influence on physician prescribing patterns, but, honestly, many physicians learn about new drugs only through this means. Busy providers of primary care--family physicians, pediatricians, general internists--do not have time to read all the studies, and spend time away from their practices at CME conferences. I worked with an inner city health management program for several years, and if it wasn't for the samples and the educational materials offered by the pharma reps, our efforts would have not been as successful. These practices relied on samples to provide routine meds to their uninsured and underinsured patients. I totally agree that there are many instances of overstepping the boundaries with pharma incentives offered to the subspecialty physicians--elaborate trips, event tickets, etc., but to take away sampling from is not the answer. There should be a happy medium out there somewhere. - Susan Thomas, MHSA Since the advent of managed care, doctors have been told they are not good business people and should adopt the principles of American business. This has become more compelling as reimbursement rates have dropped, authorization and payment procedures have become immensely more complex, and retroactive 'take-backs' have all reduced income by 30 to 60 percent per unit of work. As doctors have responded to these 'market demands' (driven more by insurers than by the public), and have become more business-like, the public does not like it. They want a caring professional who values their needs more than money. Enter the Pharma: Of course they try to influence doctors. And of course some succumb. This is true in all American business. Most non-medical businesses thrive on the gifts, dinners, golf games, outings and other perks given to decision-makers by sales, marketing and lobbying people in their industry. I think we are held to a double standard: We must be professionals when our patients, insurers and regulators want us to be held to the highest ethical standards. And we must be business people when they want us held to those standards… Let he who is without conflict-of-interest cast the first stone. Get real America. Doctors cannot do their best work in the current climate, let alone with Medicare and the other carriers offering cuts of 4 to 5 percent each year. Does a free dinner and a canned talk about a medication make me a slave? - Jerome M. Schnitt, M.D. An outside perspective I’m not in the industry, but I have pharma clients and my daughter was a specialty drug rep for a major pharma firm. Based her "war stories" there are two types of doctors: 1) Those for whom a dinner is nice to have, but isn't anything special. The dinner, especially with other doctors opens up dialogues about the drug, its efficacies, and allows the doctors to have a night out and share their "war stories.” Now they have to call these dinners continuing education, and the education has to be provided by a "third party" non affiliate of the drug company. My daughter could arrange the dinner and speaker, but couldn't speak. This seems stupid considering that the doctors may have some questions of a medical or research director. 2) There were actually some doctors who suggested you contribute to a "camp fund." My daughter caught on immediately and would not participate. She fortunately realized the "camp fund" wasn't for some program for disadvantaged children, but for the doctor’s own children. She also had some physicians stating that if a Mont Blanc pen showed up on his/her desk, more scripts might be written. In both cases there were pharma companies who would bend to the request. The new rules eliminate this "gift" abuse. Doctors are being shortchanged, but doctors shouldn't be in business. Every industry has its "sleaze" factor. Unfortunately the rules have been changed to meet the Sleaze Factor, but this also hurts the concerned physician. - Scott M. Taylor